Provider Demographics
NPI:1871572008
Name:MORELAND, KIMBERLY S (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 SOQUEL DR STE 1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-465-5440
Practice Address - Fax:831-462-2017
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263390-1205174400000X, 207V00000X
CAG171306207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG40006Medicare UPIN
UT005514801Medicare ID - Type Unspecified